Some braces utilize brackets that are adhered to the teeth. Other braces utilize removable devices. There are dental implements commonly referred to as aligners (removable braces) which are well known. One or more removable brace(s) are typically employed by orthodontists and dentists to gradually realign a patient's teeth along a desired path.
A well known aligner is made of a reasonably transparent medical grade customized plastic that fits onto a patient's teeth (hereafter flexible aligner). The desired alignment is achieved by configuring the aligner to induce the misaligned tooth/teeth to move and realign with the aid of the aligner. To treat a patient, several braces may be devised to induce the movement of the misaligned teeth gradually over a period of time. FIG. 1a shows a flexible aligner 100 configuration used in conventional orthodontic procedures and used in a method according to the present invention. A flexible aligner 100 which is a curved body 102 having a recess 104 that receives a patient's teeth. The curved body is flexible as illustrated in FIG. 1b. A flexible aligner is sometimes referred to as a removable aligner because it can be removed from the teeth and snapped back on by the patient.
It has been conventional thinking that not all patients are deemed responsive to treatment with flexible aligners. For example, according to the websites of major manufacturers of orthodontic flexible aligners, the guidelines for a patient who would be deemed unsuitable would have one of the following conditions:    1. Any type, method, or movement indicated as difficult.    2. Centric-relation and centric-occlusion discrepancies.    3. Teeth with short clinical crowns.    4. Arches with multiple missing teeth.    5. Patients whose second molars have not yet erupted.    6. Patients with poor oral hygiene.    7. Patients with active periodontal disease.    8. Doctor cannot confirm a patient is dentally and periodontally stable    9. Patients with dental prosthetics or implants.
While malocclusion has been associated with periodontal health conditions (pocket depth, gingivitis, alveolar bone loss, gingival recession, pocket depth), there is little evidence that malocclusion adversely affects the periodontium. Malocclusion can be treated through orthodontic treatment. It has been suggested that orthodontic treatment can be beneficial in the treatment of a periodontal condition. This suggestion, however, does not seem to have a clinical basis. Rather, it is based on the assumption that the orthodontic treatment may improve the patient's ability to clean the teeth once the teeth are properly aligned. Thus, it is not the treatment itself but it is the result of the treatment that is thought to be beneficial to the health of the patient's gums.
In a relatively recent study, a large number of studies were compared to determine whether orthodontic treatment will have a beneficial effect on a periodontal condition. In that study, it was determined that there was little clinical evidence suggesting that orthodontic treatment could be beneficial in resolving periodontal conditions. In fact, it was concluded that orthodontic treatment had a negative effect on the health of the periodontium. See Ann-Marie Bollen et al., The Effects of Orthodontic Therapy on Periodontal Health: A Systematic Review of Controlled Evidence, DADA, Vol. 139, April 2008.
Moreover, many clinicians are fearful that teeth classified as periodontally compromised are poor candidates for orthodontic treatment. They refuse to render teeth repositioning therapy to those patients because presently it is thought that the presence of an adverse periodontal condition indicates the likelihood of an unhealthy tooth that is less stable and suitable for orthodontic treatment. Indeed, removable flexible aligners are not recommended for patients with a periodontal condition.
According to accepted practice, to treat malocclusions, clinicians shrink the size of existing teeth (e.g. by shaving the teeth) to minimize the amount of movement, or omit certain malpositioned teeth from treatment. In addition, while it is known that the maxillary arch may be expanded, the recommended maximum expansion of the maxillary arch is 2 mm. Some reasons for these clinical choices are:    a) With prior materials and techniques, overlapped teeth required definitive space prior to the start of the repositioning or sometimes during the treatment.    b) Clinicians and patients prefer the duration of treatment to be as brief as possible to reduce the cost of treatment.    c) The belief that it will increase the likelihood that treatment will be completed prior to the patient becoming non-compliant or requesting cessation.    d) The less distance teeth need to move and the smaller the amount of rotation they require, the shorter the time necessary to accomplish those movements.    e) A significant increase in the length (antero-postero direction, front to back measurement) of the arches or large (>4 mm) arch expansion is considered to be unobtainable, non-feasible or unpredictable if the patient is post-pubescent (without surgery).    f) The severely maloccluded teeth are asymptomatic—they are neither painful nor present an annoyance (e.g., catch food, heavy bleeding) to the patient. Therefore, there is no desire to move those teeth.
As a consequence of these factors, the benefits of long term orthodontic treatment regimens have not been studied.
Pursuant to conventional thinking, clinicians or orthodontic training programs do not espouse the idealization of the axial inclinations of teeth to ensure the teeth stand as perfectly upright as clinically possible. According to standard practice, if the occlusal surface orientation is not worse than it was prior to therapy, or if there is some level of improvement, that is deemed acceptable. If a bite interference was created or not eliminated, then the standard practice is to shave away tooth structure to alleviate the problem. If the teeth are reasonably straight, but the incisal edges appear jagged, the standard practice is to shave down tooth structure to level the incisal edges. However, when the top, side, front or back of a tooth must be shaved down to help it fit better within an arch or to occlude better with the opposing arch, it is an indication that the proper or ideal orientation (axial inclination) of that tooth has not been realized.
A major problem with conventional orthodontic therapy is relapse. Relapse means that after the conclusion of orthodontic treatment the teeth return to their prior or another maloccluded state. The clinical reasons for relapse are not known and no retention therapy has been proposed to overcome the potential for relapse. See Simon J. Littlewood et al., Orthodontic Retention: A Systematic Review, Journal of Orthodontics, Vol. 33, 2006, pp. 205-212.
The inventor believes that relapse occurs because standard orthodontic therapy involving tooth repositioning does not properly align the teeth, which may further explain why standard orthodontic therapy has not been able promote the health of gingiva.
Moreover, it has been conventional thinking that alveolar bone height, once lost, could not be predictably and purposefully regenerated naturally by the body.
Loss of alveolar bone is sometimes accompanied by receding gums.
A conventional technique for offsetting the effects of the lost alveolar bone is gum grafting surgery. The three most common types of gingival graft surgeries are connective tissue grafts, free gingival grafts and pedicle grafts. While there are situations where each of these intraoral tissue surgeries will be the preferred procedure, none possesses the ability to induce the regrowth of the lost alveolar bone non-invasively.
There are clinical situations that require regrowth of dense bone, for example, a tooth implant procedure. When a tooth implant is being considered, it is often necessary and common to perform a bone graft surgical procedure at the time of the extraction. When the magnitude of the infection warrants, the bone graft placement may be performed at a second surgical procedure months after the tooth (or teeth) was (were) extracted. On infrequent occasions when the osseous defect is large and significant, a second bone grafting procedure may be required to augment the initial bone graft and enhance the suitability of the edentulous area to receive an implant.
The purpose of the bone graft procedure prior to the placement of a tooth implant is to have the bone become as dense as possible. The density of the alveolar bone is important. The more dense the bone, the more favorable the prognosis for the dental implant.
When a tooth is extracted, the new bone that will develop over the next few months to fill in the site once occupied by the extracted roots of the tooth (or teeth) will not be as dense as the existing or surrounding bone. If an implant were to be placed in bone that was less dense, the time required for osseointegration would be longer when compared to a site where the bone was denser and more favorable. It is possible for an area of bone to lack adequate density to withstand the placement of a dental implant altogether.
In addition, currently, the treatment options for a non-restorable maxillary first molar or an existing edentulous space in the region of the maxillary first molar are also limited. Presently, two of the more common eventual treatment options for the space after the extraction (or if already edentulous) are a dental implant (implant abutment and crown) and a 3-unit fixed bridge.
On occasion, the inferior portion of the maxillary sinus is quite close to the alveolar ridge. So little bone may be available, that the insufficient height will preclude the placement of a standard length implant, or on occasion, the placement of a reduced size or minimal length implant.
In such cases, a popular method to create an adequate amount of bone to satisfy the proper surgical and prosthetic implant requirements is to perform a sinus lift or sinus augmentation surgery.
Sinus lift surgery is accomplished by adding bone material between the sinus and the existing maxillary bone. During the surgery a membrane from the sinus is repositioned in a manner that will allow bone graft material to be placed. The goal is to have the inferior portion of the sinus repositioned so it is farther away from (creates a greater distance) the alveolar ridge. That additional space will allow for the bone graft material to harden, become utilizable and eventually enhance the quantity of bone available for an implant placement in the area.
In short, many known treatment plans require invasive and surgical procedures in order to attain dense bone.
The evidence presented herein establishes that through a regimen according to the present invention, a patient suffering from maloccluded teeth and a periodontal condition can be successfully treated.
The evidence presented herein further show that other orthodontic conditions may be treated with a regimen according to the present invention with a higher chance of avoiding relapse.
The evidence presented herein will further show that a regimen according to the present invention may be employed to grow alveolar bone without grafting or other invasive dental procedure.